Post-deployment Mental Health Screening: A Systematic Review of Current Evidence and Future Directions

  • Vanessa Panaite
  • Racine Brown
  • Michelle Henry
  • Amanda Garcia
  • Gail Powell-Cope
  • Rodney D. Vanderploeg
  • Heather G. Belanger
Original Article
  • 47 Downloads

Abstract

Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.

Keywords

Mental health screening Depression PTSD Alcohol TBI 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving with Animal and Human Participants

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5). Washington: American Psychiatric Association.CrossRefGoogle Scholar
  2. Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., … Hatcher, S. (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. The Annals of Family Medicine, 8(4), 348–353.CrossRefPubMedGoogle Scholar
  3. Belanger, H. G., Vanderploeg, R. D., & Sayer, N. (2016). Screening for remote history of mild traumatic brain injury in VHA: A critical literature review. The Journal of Head Trauma Rehabilitation, 31(3), 204–214.CrossRefPubMedGoogle Scholar
  4. Bliese, P., Wright, K., Adler, A., Hoge, C., & Prayner, R. (2005). Post-deployment psychological screening: Interpreting and scoring DD Form 2900. US Army Medical Research Unit-Europe Research Report, 3.Google Scholar
  5. Bliese, P. D., Wright, K., Adler, A. B., & Thomas, J. (2004). Validation of the 90 to 120 day post-deployment psychological short screen (U.S. Army Medical Research Unit—Europe Report No. 2004–002). Heidelberg: USAMRU-E.Google Scholar
  6. Bliese, P. D., Wright, K. M., Adler, A. B., et al. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76(2), 272–281.CrossRefPubMedGoogle Scholar
  7. Bradley, K. A., Chavez, L. J., Lapham, G. T., Williams, E. C., Achtmeyer, C. E., Rubinsky, A. D., … Kivlahan, D. R. (2013). When quality indicators undermine quality: Bias in a quality indicator of follow-up for alcohol misuse. Psychiatric Services, 64(10), 1018–1025.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bradley, K. A., DeBenedetti, A. F., Volk, R. J., et al. (2007). AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical and Experimental Research, 31(7), 1208–1217.CrossRefGoogle Scholar
  9. Calhoun, P. S., McDonald, S. D., Guerra, V. S., Eggleston, A. M., Beckham, J. C., Straits-Troster, K., & Mid-Atlantic, V. A., MIRECC OEF/OIF Registry Workgroup. (2010). Clinical utility of the primary care-PTSD screen among US veterans who served since September 11, 2001. Psychiatry Research, 178(2), 330–335.CrossRefPubMedGoogle Scholar
  10. Carlson, K. F., Nelson, D., Orazem, R. J., Nugent, S., Cifu, D. X., & Sayer, N. A. (2010). Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury. Journal of Traumatic Stress, 23(1), 17–24.PubMedGoogle Scholar
  11. Crawford, E. F., Fulton, J. J., Swinkels, C. M., Beckham, J. C., Calhoun, P. S., & Mid-Atlantic, V. A., MIRECC OEF/OIF Registry Workgroup. (2013). Diagnostic efficiency of the AUDIT-C in US veterans with military service since September 11, 2001. Drug and Alcohol Dependence, 132(1), 101–106.CrossRefPubMedGoogle Scholar
  12. Denneson, L. M., Corson, K., Helmer, D. A., Bair, M. J., & Dobscha, S. K. (2014). Mental health utilization of new-to-care Iraq and Afghanistan Veterans following suicidal ideation assessment. Psychiatry Research, 217(3), 147–153.CrossRefPubMedGoogle Scholar
  13. Department of Veterans Affairs. (2015). Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans. http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2015-qtr2.pdf. Accessed 11 May 2016.
  14. Department of Veterans Affairs and Department of Defense. (2009). VA/DoD clinical practice guideline for management of major depressive disorder (MDD). Washington, DC: Office of Quality and Performance, VA and Quality Management Directorate, United States Army MEDCOM.Google Scholar
  15. Department of Veterans Affairs and Department of Defense. (2010). VA/DoD clinical practice guidelines for management of post-traumatic stress. Washington, DC: Office of Quality and Safety, VA and Quality Management Division, United States ArmyMEDCOM.Google Scholar
  16. Department of Veterans Affairs and Department of Defense. (2015). VA/DoD clinical practice guideline for the management of substance use disorders. Washington, DC: Office of Quality, Safety and Value, VHA and Office of Evidence Based Practice, US Army Medical CommandGoogle Scholar
  17. Dobscha, S. K., Corson, K., Helmer, D. A., Bair, M. J., Denneson, L. M., Brandt, C., … Ganzini, L. (2013). Brief assessment for suicidal ideation in OEF/OIF veterans with positive depression screens. General Hospital Psychiatry, 35(3), 272–278.CrossRefPubMedGoogle Scholar
  18. Donnelly, K. T., Donnelly, J. P., Dunnam, M., Warner, G. C., Kittleson, C. J., Constance, J. E., … Alt, M. (2011). Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool. The Journal of Head Trauma Rehabilitation, 26(6), 439–453.CrossRefPubMedGoogle Scholar
  19. Eisen, S. V., Schultz, M. R., Vogt, D., Glickman, M. E., Elwy, A. R., Drainoni, M. L., … Martin, J. (2012). Mental and physical health status and alcohol and drug use following return from deployment to Iraq or Afghanistan. American Journal of Public Health, 102(S1), S66–S73.CrossRefGoogle Scholar
  20. Evans, C. T., Andre, J. R., Pape, T. L., Steiner, M. L., Stroupe, K. T., Hogan, T. P., Weaver, F. M., Smith, B. M. (2013). An evaluation of the Veterans Affairs traumatic brain injury screening process among Operation Enduring Freedom and/or Operation Iraqi Freedom veterans. PM&R, 5(3), 210–220.CrossRefGoogle Scholar
  21. Fortier, C. B., Amick, M. M., Kenna, A., Milberg, W. P., & McGlinchey, R. E. (2015). Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) clinical interview and the VA TBI screen. The Journal of Head Trauma Rehabilitation, 30(1), E1.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Grossbard, J., Malte, C. A., Lapham, G., Pagulayan, K., Turner, A. P., Rubinsky, A. D., … Hawkins, E. J. (2017). Prevalence of alcohol misuse and follow-up care in a national sample of OEF/OIF VA patients with and without TBI. Psychiatric Services, 68(1), 48–55.CrossRefPubMedGoogle Scholar
  23. Grossbard, J. R., Hawkins, E. J., Lapham, G. T., Williams, E. C., Rubinsky, A. D., Simpson, T. L., … Bradley, K. A. (2013). Follow-up care for alcohol misuse among OEF/OIF veterans with and without alcohol use disorders and posttraumatic stress disorder. Journal of substance abuse treatment, 45(5), 409–415.CrossRefPubMedGoogle Scholar
  24. Harmon, S. C., Hoyt, T. V., Jones, M. D., Etherage, J. R., & Okiishi, J. C. (2012). Postdeployment mental health screening: an application of the Soldier Adaptation Model. Military Medicine, 177(4), 366–373.CrossRefGoogle Scholar
  25. Harris, R., Sawaya, G. F., Moyer, V. A., & Calonge, N. (2011). Reconsidering the criteria for evaluating proposed screening programs: Reflections from 4 current and former members of the US Preventive services task force. Epidemiologic Reviews, 33(1), 20–35.CrossRefPubMedGoogle Scholar
  26. Hawkins, E. J., Lapham, G. T., Kivlahan, D. R., & Bradley, K. A. (2010). Recognition and management of alcohol misuse in OEF/OIF and other veterans in the VA: A cross-sectional study. Drug and Alcohol Dependence, 109(1), 147–153.CrossRefPubMedGoogle Scholar
  27. Hendricks, A. M., Amara, J., Baker, E., Charns, M. P., Gardner, J. A., Iverson, K. M., Kimerling, R., Krengel, M., Meterko, M., Pogoda, T. K., & Stolzmann, K. L. (2013). Screening for mild traumatic brain injury in OEF-OIF deployed US military: An empirical assessment of VHA’s experience. Brain Injury, 27(2), 125 – 34.CrossRefPubMedGoogle Scholar
  28. Hoge, C. W., Auchterlonie, J. L., & Milliken, C. S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Jama, 295(9), 1023–1032.CrossRefPubMedGoogle Scholar
  29. Hoggatt, K. J., Jamison, A. L., Lehavot, K., Cucciare, M. A., Timko, C., & Simpson, T. L. (2015). Alcohol and drug misuse, abuse, and dependence in women veterans. Epidemiologic Reviews, 37(1), 23–37.CrossRefPubMedGoogle Scholar
  30. Joffres, M., Jaramillo, A., Dickinson, J., Lewin, G., Pottie, K., & Shaw, E. … Canadian Task Force on Preventive Health Care. (2013). Recommendations on screening for depression in adults. Canadian Medical Association Journal, 185(9), 775–782.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.CrossRefPubMedGoogle Scholar
  32. Kessler, R. C., & Wang, P. S. (2009). The epidemiology of depression. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression, vol. 2 (pp. 5–22). New York: Guilford.Google Scholar
  33. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med Care, 41(11), 1284–1292.CrossRefPubMedGoogle Scholar
  34. Larson, M. J., Mohr, B. A., Adams, R. S., Wooten, N. R., & Williams, T. V. (2014). Missed opportunity for alcohol problem prevention among Army active duty service members postdeployment. American Journal of Public Health, 104(8), 1402–1412.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Lu, M. W., Duckart, J. P., O’Malley, J. P., & Dobscha, S. K. (2011). Correlates of utilization of PTSD specialty treatment among recently diagnosed veterans at the VA. Psychiatric Services, 62(8), 943–949.CrossRefPubMedGoogle Scholar
  36. Luxton, D. D., Skopp, N. A., & Maguen, S. (2010). Gender differences in depression and PTSD symptoms following combat exposure. Depression and Anxiety, 27(11), 1027–1033.CrossRefPubMedGoogle Scholar
  37. Maguen, S., Lau, K. M., Madden, E., & Seal, K. (2012a). Relationship of screen-based symptoms for mild traumatic brain injury and mental health problems in Iraq and Afghanistan veterans: Distinct or overlapping symptoms? Journal of Rehabilitation Research and Development, 49(7), 1115.CrossRefPubMedGoogle Scholar
  38. Maguen, S., Lau, K. M., Madden, E., & Seal, K. (2012b). Factors associated with completing comprehensive traumatic brain injury evaluation. Military Medicine, 177(7), 797.CrossRefPubMedGoogle Scholar
  39. Maguen, S., Madden, E., Lau, K. M., & Seal, K. (2012). The impact of head injury mechanism on mental health symptoms in veterans: Do number and type of exposures matter? Journal of Traumatic Stress, 25(1), 3–9.CrossRefPubMedGoogle Scholar
  40. Maguen, S., Madden, E., Lau, K. M., & Seal, K. H. (2013). Service utilization among Iraq and Afghanistan veterans screening positive for traumatic brain injury. Journal of Neurotrauma, 30(13), 1123–1128.CrossRefPubMedGoogle Scholar
  41. Martin, C. B. (2007). Routine screening and referrals for PTSD after returning from Operation Iraqi Freedom in 2005, US Armed Forces. MSMR: Medical Surveillance Monthly Report, 14(6), 2–7.Google Scholar
  42. Merikangas, K. R., & McClair, V. L. (2012). Epidemiology of substance use disorders. Human Genetics, 131(6), 779–789.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Jama, 298(18), 2141–2148.CrossRefPubMedGoogle Scholar
  44. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine 6(7): e1000097.  https://doi.org/10.1371/journal.pmed1000097.CrossRefGoogle Scholar
  45. Moyer, V. A. (2013). Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: US preventive services task force recommendation statement. Annals of Internal Medicine, 159(3), 210–218.PubMedGoogle Scholar
  46. National Collaborating Center for Mental Health. (2010). The NICE guideline on the management and treatment of depression in adults (Updated edition). Manchester: NICE.Google Scholar
  47. Polusny, M. A., Kehle, S. M., Nelson, N. W., Erbes, C. R., Arbisi, P. A., & Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Archives of General Psychiatry, 68(1), 79–89.CrossRefPubMedGoogle Scholar
  48. Prins, A., Ouimette, P., Kimerling, R., et al. (2003). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 9–14.CrossRefGoogle Scholar
  49. Sayer, N. A., Carlson, K. F., & Frazier, P. (2014). Reintegration challenges in U.S service members and veterans following combat deployment. Social Issues and Policy Research, 8, 33–73.CrossRefGoogle Scholar
  50. Sayer, N. A., Nelson, D., & Nugent, S. (2011). Evaluation of the Veterans Health Administration traumatic brain injury screening program in the upper Midwest. The Journal of head trauma rehabilitation, 26(6), 454–467.CrossRefPubMedGoogle Scholar
  51. Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric Services, 61(6), 589–597.CrossRefPubMedGoogle Scholar
  52. Schneiderman, A. I., Braver, E. R., & Kang, H. K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167(12), 1446–1452.CrossRefPubMedGoogle Scholar
  53. Schwab, K. A., Ivins, B., Cramer, G., et al. (2007). Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: Initial investigation of the usefulness of a short screening tool for traumatic brain injury. The Journal of head trauma rehabilitation, 22(6), 377–389.CrossRefGoogle Scholar
  54. Seal, K. H., Bertenthal, D., Maguen, S., Gima, K., Chu, A., & Marmar, C. R. (2008). Getting beyond “Don’t ask; don’t tell”: an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. American Journal of Public Health, 98(4), 714–720.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Seal, K. H., Cohen, G., Waldrop, A., Cohen, B. E., Maguen, S., & Ren, L. (2011). Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis and treatment. Drug and Alcohol Dependence, 116(1), 93–101.CrossRefPubMedGoogle Scholar
  56. Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health, 99(9), 1651–1658.CrossRefPubMedPubMedCentralGoogle Scholar
  57. Sherriff, R., Best, L., & Roderick, P. (1998). Population screening in the NHS: A systematic pathway from evidence to policy formulation. Journal of Public Health Medicine, 20, 58–62.CrossRefPubMedGoogle Scholar
  58. Shiner, B., Tang, C., Trapp, A. C., Konrad, R., Bar-On, I., & Watts, B. V. (2014). The provision of mental health treatment after screening: Exploring the relationship between treatment setting and treatment intensity. General Hospital Psychiatry, 36(6), 581–588.CrossRefPubMedGoogle Scholar
  59. Sigford, B. J. (2008). To care for him who shall have borne the battle and for his widow and his orphan (Abraham Lincoln): The Department of Veterans Affairs polytrauma system of care. Archieves of Physical Medicine Rehabilitation, 89(1), 160–162.CrossRefGoogle Scholar
  60. Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., … Krist, A. H. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. Jama, 315(4), 380–387.CrossRefPubMedGoogle Scholar
  61. Stroupe, K. T., Smith, B. M., Hogan, T. P., et al. (2013). Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury. Journal of Rehabilitation Research and Development, 50(8), 1047–1068.CrossRefPubMedGoogle Scholar
  62. Tanielian, T., & Jaycox, L. H. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: The RAND Center for Military Health Policy Research.Google Scholar
  63. Terrio, H. P., Nelson, L. A., Betthauser, L. M., Harwood, J. E., & Brenner, L. A. (2011). Postdeployment traumatic brain injury screening questions: Sensitivity, specificity, and predictive values in returning soldiers. Rehabilitation Psychology, 56(1), 26.CrossRefPubMedGoogle Scholar
  64. Thombs, B. D., & Ziegelstein, R. C. (2014). Does depression screening improve depression outcomes in primary care? BMJ: British Medical Journal (Online), 348, g1253.CrossRefGoogle Scholar
  65. Thombs, B. D., Ziegelstein, R. C., Roseman, M., Kloda, L. A., & Ioannidis, J. P. (2014). There are no randomized controlled trials that support the United States Preventive Services Task Force guideline on screening for depression in primary care: A systematic review. BMC Medicine, 12(1), 13.CrossRefPubMedPubMedCentralGoogle Scholar
  66. U.S. Preventive Services Task Force. (2015). Procedure manual.Google Scholar
  67. Valenstein, M., Vijan, S., Zeber, J. E., Boehm, K., & Buttar, A. (2001). The cost–utility of screening for depression in primary care. Annals of Internal Medicine, 134(5), 345–360.CrossRefPubMedGoogle Scholar
  68. Vanderploeg, R. D., & Belanger, H. G. (2013). Screening for a remote history of mild traumatic brain injury: When a good idea is bad. The Journal of Head Trauma Rehabilitation, 28(3), 211–218.CrossRefPubMedGoogle Scholar
  69. Vanderploeg, R. D., & Belanger, H. G. (2016). Stability and validity of the VA’s TBI Clinical Reminder Screen. Journal of Head Trauma Rehabilitation, 30(5), E29–E39.Google Scholar
  70. Vanneman, M. E., Harris, A. H., Chen, C., Adams, R. S., Williams, T. V., & Larson, M. J. (2017). Postdeployment Behavioral Health Screens and Linkage to the Veterans Health Administration for Army Reserve Component Members. Psychiatric Services, appi-ps.Google Scholar
  71. Veterans Health Administration. (2004). Iraq & Afghan Post-Deployment Screen.Google Scholar
  72. Veterans Health Administration. (2007). Iraq & Afghan Post-Deployment Screen.Google Scholar
  73. Warner, C. H., Appenzeller, G. N., Grieger, T., Belenkiy, S., Breitbach, J., Parker, J., Warner, C. M., & Hoge, C. (2011). Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. Archives of General Psychiatry, 68(10), 1065–1071.CrossRefPubMedGoogle Scholar
  74. Wilk, J. E., Herrell, R. K., Wynn, G. H., Riviere, L. A., & Hoge, C. W. (2012). Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in US soldiers involved in combat deployments: Association with postdeployment symptoms. Psychosomatic Medicine, 74(3), 249–257.CrossRefPubMedGoogle Scholar
  75. Williams, J. L., McDevitt-Murphy, M. E., Murphy, J. G., & Crouse, E. M. (2017). Postconcussive symptoms, PTSD, and medical disease burden in treatment-seeking OEF/OIF/OND Veterans. Military Medicine, 182(3–4), e1645–e1650.CrossRefPubMedPubMedCentralGoogle Scholar
  76. Wilson, J. M. G., & Jungner, G. (1968). Principles and practice of screening for disease. Geneva: WHO. http://www.who.int/bulletin/volumes/86/4/07-050112BP.pdf. Accessed 11 Feb 2016.
  77. Wright, K. M., Bliese, P. D., Thomas, J. L., Adler, A. B., Eckford, R. D., & Hoge, C. W. (2008). Contrasting approaches to psychological screening with U.S. combat soldiers. Journal of Traumatic Stress, 20(6), 965–975Google Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Vanessa Panaite
    • 1
    • 4
  • Racine Brown
    • 1
  • Michelle Henry
    • 2
  • Amanda Garcia
    • 3
  • Gail Powell-Cope
    • 1
  • Rodney D. Vanderploeg
    • 3
    • 4
    • 5
    • 6
  • Heather G. Belanger
    • 1
    • 3
    • 5
    • 6
  1. 1.HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR)James A. Haley Veterans’ HospitalTampaUSA
  2. 2.University of FloridaGainesvilleUSA
  3. 3.Department of Mental Health and Behavioral SciencesJames A. Haley VATampaUSA
  4. 4.Departments of PsychologyUniversity of South FloridaTampaUSA
  5. 5.Psychiatry & Behavioral NeurosciencesUniversity of South FloridaTampaUSA
  6. 6.Defense and Veterans Brain Injury CenterTampaUSA

Personalised recommendations